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2002 Progress Report: A Community-Based Intervention to Reduce Environmental Triggers for Asthma Among Children (Asthma Intervention)

EPA Grant Number: R826710C003
Subproject: this is subproject number 003 , established and managed by the Center Director under grant R826710
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
Center: Michigan Center for the Environment and Children’s Health
Center Director: Israel, Barbara A.
Title: A Community-Based Intervention to Reduce Environmental Triggers for Asthma Among Children (Asthma Intervention)
Investigators: Israel, Barbara A. , Brown, Randall , Keeler, Gerald J. , Lin, Xihong , Parker, Edith , Philbert, Martin , Remick, Daniel , Robins, Thomas
Institution: University of Michigan - Ann Arbor
EPA Project Officer: Saint, Chris
Project Period: January 1, 1998 through January 1, 2002
Project Period Covered by this Report: January 1, 2001 through January 1, 2002
Project Amount: Refer to main center abstract for funding details.
RFA: Centers for Children's Environmental Health and Disease Prevention Research (1998)
Research Category: Children's Health , Health Effects

Description:

Objective:

Core 1: Community-Based Intervention to Reduce Environmental Triggers for Asthma Among Children, and
Core 2: Indoor and Outdoor Air Contaminant Exposures

Please note: The Intervention and Exposure Cores of MCECH continue to have the same specific aims as stated in the proposal, but because the two are so integrated and have the same participants and current goals, their research teams and activities have been combined into one "meta"-project called: Community Action Against Asthma, or CAAA. A Steering Committee, which meets monthly and is comprised of the university and Detroit community partners involved in both projects, oversees and is directly involved in decision making and other activities regarding the implementation of the research protocol. A separate Research Work Group, comprised of the university-based faculty and staff for CAAA, oversees the technical aspects of research issues and works closely and in coordination with the CAAA Steering Committee.

Specific Aims and Significance: There have been no changes in the specific aims. The asthma intervention core will test the ability of individually tailored interventions to reduce exposure to environmental contaminants and to improve asthma related health status. At the same time, the intervention will provide direct benefit to the children and families enrolled in the study. The central hypothesis being addressed in the asthma exposure core is that exposure to ambient air contaminants will aggravate the health status of asthmatic children largely through the potentiation of the adverse effects of common indoor air contaminants. Proving or refuting this hypothesis will lead to substantial advances in scientific knowledge and have a direct impact on public health recommendations.

Progress Summary:

Household Intervention: Nearly 150 wave one families received the intensive intervention, which began in March 2000 and consisted of at least nine home visits. Starting in May of 2001, wave two families began receiving this intensive intervention and later in the year after a transition visit, wave one families began receiving the less frequent "support" visits, expected to total three per year. The Community Environmental Specialists (CES's) conducted these home visits which were tailored to the individual needs of the families and involved help with a variety of topics including cleaning, stopping smoking, asthma education, and pest control. The CES's are currently conducting closure visits with the wave one families as they end the intervention with the project. They are also conducting transition visits for wave two families moving from the intensive to the support visit phase.

Because of the ongoing recognition of the tremendous need to address the problem of household pests--particularly cockroaches and mice--which are major asthma triggers for many children, the CES's continued conducting integrated pest management (IPM) in the homes of wave two families as they had with wave one families. This problem is most often credited to the old, dilapidated housing stock in much of the target area. For the more serious cockroach infestations, the CES's continued to work with a professional pest control company and treated over thirty wave two homes. Helping families control these pests has markedly improved the quality of life for many families participating in the project and is noted by the CES's as one of the most positive contributions of the project.

Interviews: Annual surveys of all project participants were conducted by community interviewers recruited, trained, and hired by the project prior to the start of the second wave visits. These surveys include a caregiver interview, a household walk-through, household dust collection and a child survey. Twenty community interviewers were recently trained and hired to repeat this annual interview process, which commenced in August 2002.

Retention: Activities to retain participants conducted the past year include: the publication of newsletters (which included a raffle and a contest) a fact sheet, a holiday card, and birthday cards, which were sent to all participants. Also every season each family is visited by an Airwatch or diary distributor and receives at least two telephone calls.

Exposure Assessment: A total of eleven seasonal assessments of environmental exposure and asthma status have been conducted. These consisted of. indoor and outdoor daily air quality measurements from two elementary schools; personal monitoring where a sub-set of children wore back-packs with devices that collect information on particulate matter, and indoor air sampling, where machines with special filters were installed in the homes of this same sub-set of children to obtain indoor air quality information, both for a one-week period each season; and measurements of lung functioning, which were taken through use of an "Airwatch Monitor," a device distributed to families each season; and a daily diary where families recorded asthma symptoms and medication use during this same time period. For the last season all the children using the Airwatches also had spirometry measurements taken, to check the accuracy and validity of the Airwatch devices.

Collaboration/coordination with other projects: CAAA collaborated with staff from Michigan State University through the use of a Mobile Research Unit housed at an elementary school on the southwest side. The Mobile Unit helped collect data to study the effects of concentrated particulate matter on test animals. As a part of World Asthma Day, Dr. Peyton Eggleston from Johns Hopkins met with project staff to talk about possible future directions for CAAA. Staff also attended the quarterly Detroit Asthma Coalition meeting to keep in touch with their activities.

Media coverage: CAAA participated in a televised "Health Minute," which appeared on several news programs and featured in major article in the Detroit News, featuring our CES's and family members. The CES's participated in many community health fairs to spread information about asthma triggers and asthma resources to interested community members.

Data analysis and interpretation of findings: This has been a major focus of the project this past year. A feedback session for the families who had indoor air sampling machines in their homes (and whose children carried backpacks with personal monitoring devices) was held in May to present the results of air sampling in their home and community.

Publications and Presentations:

Please refer to the main center progress report.

Journal Articles:

No journal articles submitted with this report: View all 3 publications for this subproject

Supplemental Keywords:

Children's Health, asthma, community-based intervention, indoor air quality, human health risk, human exposure, particulate matter, environmental monitoring, Michigan, exposure assessment. , Air, Scientific Discipline, Health, RFA, Susceptibility/Sensitive Population/Genetic Susceptibility, Biology, indoor air, Risk Assessments, genetic susceptability, Health Risk Assessment, Children's Health, Environmental Chemistry, Allergens/Asthma, exposure assessment, environmentally caused disease, environmental hazard exposures, allergen, environmental tobacco smoke, health effects, indoor air quality, inhalation, dust , mold, dust mite, indoor environment, second hand smoke, cigarette smoke, assessment of exposure, childhood respiratory disease, dust mites, human health risk, toxics, epidemeology, cockroaches, community-based intervention, respiratory, sensitive populations, biological response, dander, environmental triggers, airway disease, children, tobacco smoke, disease, exposure, household, school based study, environmental health hazard, asthma triggers, allergic response, asthma, human exposure, Human Health Risk Assessment

Progress and Final Reports:
1999 Progress Report
2000 Progress Report
Original Abstract


Main Center Abstract and Reports:
R826710    Michigan Center for the Environment and Children’s Health

Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
R826710C001 Indoor and Outdoor Air Contaminant Exposures and Asthma Aggravation Among Children (Asthma Exposure)
R826710C002 Chemokines in the Pathogenesis of Asthma (Asthma Chemokines)
R826710C003 A Community-Based Intervention to Reduce Environmental Triggers for Asthma Among Children (Asthma Intervention)

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The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.

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